| NPI | 1639432073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO175537) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT014927) |
| 207R00000X Internal Medicine (Licence: PA OT014927) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-06-13 |